Ok, work in process is an urban fantasy. One of the "rules" is that Astral Projection (spirit/consciousness leaving the body) is real. The catch is: When you leave your body, after just a few seconds, you stop breathing. The in-universe result of this is that very few people who are capable of using astral projection actually do so because they either: 1. Died the first time or 2. Returned to their body so quickly they gained nothing useful from the experience (except they didn't die).

One bad guy character figured this out and set up essentially a ICU room in his house so he can astral project for extended periods (think less than an hour at a time) and stay alive. The main characters find this and don't know what it's for at the time but figure it out later. So, what medical equipment would be necessary for this to work? I've got some ideas but need more input.

Off the top of my head I'm thinking: EKG machine
Pacemaker (external or maybe even internal)
Ventilator
Defib
I'm thinking something along the lines of: He astral projects. Breathing stops, heart will stop soon. Equipment is used to breath for him (vent, right? Is there a version that doesn't require surgery/insertion of tube in neck) EKG is used to monitor heart and if/when irregular beat is detected defib is used. I'm not 100% clear on how this would work. Assume no that money and access to equipment isn't an issue. If needed, I could have another character be with him (Dr/Nurse/PA,etc) when he does this although an automated system would be cool if it can seem believable. (He'd hook himself up, set a timer, and then things would automatically happen to keep him alive and revieve him as needed).

Later, one of the main characters does a cruder version of this where she astral projects while someone performs CPR on her the whole time. After a few minutes (five or less) they hook her up to AED to essentially shock her back into her body as was decided earlier.

Any input is appreciated. I know I may have some basic assumptions incorrect

MaeZe

09-05-2016, 09:12 AM

Are you saying respirations stop, or all functions stop including cardiac rhythm?

Respirations are easy, one only requires a ventilator. But it's trickier than that, you need to be intubated. Your character would need a trach that he keeps plugged until he puts himself on the ventilator. So no, you can't do this easily without someone intubating the person. You can't just stick a tube down your throat without visualizing the epiglottis and expect to get the tube in the right place. Why not have a plugged trach opening?

There is a device that will physically pump the heart, compressing the chest, but that's not practical. I suggest an internal pacemaker that simply stimulates the heart electrically without the brain needing to do it. Internal pacemakers are programable externally via transcutaneousl pacing. (https://en.wikipedia.org/wiki/Transcutaneous_pacing) Your character can turn the thing on and off by this means.

josephperin

09-05-2016, 09:49 AM

If the only thing that happens is him stopping breathing, would recommend having medical provider intubate him. Once oxygenation is kept steady, his heart rhythm would likely stay steady. Intubation these days is mostly orotracheal - meaning, a tube passed through the mouth into the trachea. When done electively, it is usually performed under sedation to avoid pain and discomfort.

Tube in the neck (tracheostomy) is usually done for intubation lasting beyond a certain timeframe (usually at least a couple of weeks). Your character can also have a tracheostomy placed electively (would need a doctor with flexible ethics) and place himself on a ventilator. He would still need a provider by his side in case something goes wrong.

In case you want to make him totally insane, he can also have an ICD implanted which could defibrillate him.

So, tracheostomy + ICD - he may be able to do this himself, provided he has a handy ventilator.

PS - No idea why, but I feel compelled to add DO NOT TRY THIS AT HOME.

Trebor1415

09-05-2016, 11:58 AM

Are you saying respirations stop, or all functions stop including cardiac rhythm?

Whichever will work best for the story. Right now I'm thinking respiration stops which, if untreated, leads to disrupted cardiac rythm. Hence the need for a defib if/when the non standard cardiac rythmns start.

Respirations are easy, one only requires a ventilator. But it's trickier than that, you need to be intubated. Your character would need a trach that he keeps plugged until he puts himself on the ventilator. So no, you can't do this easily without someone intubating the person. You can't just stick a tube down your throat without visualizing the epiglottis and expect to get the tube in the right place. Why not have a plugged trach opening?

A trach would work. In fact, part of the back story about how he discovered his ability to astra project and not die could be that was in a coma after a car accident or something and had a vent. He astral projected while in the coma, survived and came out of the coma later, and then realized the astral projection was real and not just a coma or drug induced dream.

So he could have a pluged trach and hire unethical specialists to oversee him medically when he does this later. (He would have the resources)

There is a device that will physically pump the heart, compressing the chest, but that's not practical. I suggest an internal pacemaker that simply stimulates the heart electrically without the brain needing to do it. Internal pacemakers are programable externally via transcutaneousl pacing. (https://en.wikipedia.org/wiki/Transcutaneous_pacing) Your character can turn the thing on and off by this means.

So have him have the same unethical Doctors insert the pacemaker then? (Assuming he pays enough). Or do i need the pacemaker to also be a "leftover" from the accident?

To give an idea, this guy isn't "Lex Luther" rich and evil, but he is rich and evil, so money to hire unethical med professionals and buy state of teh art equipment isn't a problem. Just getting the tech stuff right at this point is good.

Trebor1415

09-05-2016, 12:01 PM

So, back to the original question: What equipment would the characters find in this ICU style room?

Packemaker is internal. Any controls or monitors for that besides standard EKG?

Vent for the trach.

IV's?

Defib in case of emergency? Or does internal pacemaker make that not needed?

Also, the "budget version" of this when the main character tries it by having someone perform CPR on her for five minutes or so while she's out of her body and then using a AED to shock her back. That work?

GeorgeK

09-05-2016, 07:57 PM

For positive pressure ventilation a pharangeal or laryngeal cuff (I've seen anesthesiologists get into arguments over what it should be called) in place of a formal ET tube normally works well for a surgery under one hour and does not require visualization of the trachea and does not give patients the sore throat or hoarse voice like an ET tube. Think of it as a tube that is a bit flared at the end and stops above the trachea and has a large cuff balloon that seats it in place in such a way as to hold the trachea open. Someone able to control their gag reflex (maybe spray some lidocaine into the back of the throat) theoretically could place it on themself. If the heart stopping is merely due to the hypoxia of not breathing then all they'd need is a cuff and ventilator that they could theoretically do and set the controls on their own assuming they can also get back into their body on their own. If it's only an hour then no IV would technically be needed. Of course that assumes no complications.

For negative pressure ventilation use an old iron lung.

frimble3

09-06-2016, 12:38 AM

GeorgeK, as I was reading down the thread, 'iron lung' sprung to my mind half way down.
If all the other problems: cardiac, etc, are just a cascade of failures from the inability to breath, then if the iron lung continues to breath for the 'patient', then all the racing around with inserting things in the throat, trying restart the heart at the right time, etc, wouldn't have to be part of the regular process (which struck me as risky).
Also, people have been kept in iron lungs for years, so there'd be no limit on the astral travelling.
He'd still need medical supervision, I imagine, but it wouldn't be as life-threatening.

I don't know the medical details, but it seems a much simpler process, if all that's needed is to keep the patient breathing.

MaeZe

09-06-2016, 01:17 AM

For positive pressure ventilation a pharangeal or laryngeal cuff (I've seen anesthesiologists get into arguments over what it should be called) in place of a formal ET tube normally works well for a surgery under one hour and does not require visualization of the trachea and does not give patients the sore throat or hoarse voice like an ET tube. Think of it as a tube that is a bit flared at the end and stops above the trachea and has a large cuff balloon that seats it in place in such a way as to hold the trachea open. Someone able to control their gag reflex (maybe spray some lidocaine into the back of the throat) theoretically could place it on themself. If the heart stopping is merely due to the hypoxia of not breathing then all they'd need is a cuff and ventilator that they could theoretically do and set the controls on their own assuming they can also get back into their body on their own. If it's only an hour then no IV would technically be needed. Of course that assumes no complications.

For negative pressure ventilation use an old iron lung.

I'm not picturing what you are describing in your first paragraph but you cannot stick a tube down your throat and get it in the trachea without looking. You use a laryngoscope blade, like a shoehorn, to hold the epiglottis out of the way then slide the tube through the glottis into the trachea. Otherwise the tube will just go down the esophagus, gag reflex or not.

As for the cuff, yes, once the tube is in place, you seal around it by inflating a cuff. If you don't then anything in the esophagus can spill into the trachea and air pushed in by the ventilator will just leak out around the tube.

What I was thinking was something like a permanent tracheotomy (http://www.circlecity.co.uk/sleepdesk/tracheostomy.php) that stays capped when not in use.

But I like your idea of an old fashioned iron lung. Plus that has the added benefit of assisting circulation. It exposes the whole chest to negative pressure thus pulling air into the lung instead of pushing it in. When we inhale, we also create negative pressure in the major veins around the heart and that assists blood return to the heart.

Trebor1415

09-06-2016, 02:41 AM

I'm not picturing what you are describing in your first paragraph but you cannot stick a tube down your throat and get it in the trachea without looking. You use a laryngoscope blade, like a shoehorn, to hold the epiglottis out of the way then slide the tube through the glottis into the trachea. Otherwise the tube will just go down the esophagus, gag reflex or not.

As for the cuff, yes, once the tube is in place, you seal around it by inflating a cuff. If you don't then anything in the esophagus can spill into the trachea and air pushed in by the ventilator will just leak out around the tube.

What I was thinking was something like a permanent tracheotomy (http://www.circlecity.co.uk/sleepdesk/tracheostomy.php) that stays capped when not in use.

But I like your idea of an old fashioned iron lung. Plus that has the added benefit of assisting circulation. It exposes the whole chest to negative pressure thus pulling air into the lung instead of pushing it in. When we inhale, we also create negative pressure in the major veins around the heart and that assists blood return to the heart.

Thanks for the tip on the iron lung. I like the "WTF" factor when the characters find it in the bedroom (empty) and can't figure out why he has it.

Now off to research iron lungs.

GeorgeK

09-06-2016, 06:54 PM

I'm not picturing what you are describing in your first paragraph but you cannot stick a tube down your throat and get it in the trachea without looking. A pharyngeal cuff (I don't remember the exact name, I've been retired for over a decade) does not go into the trachea. It's not an ET tube. It rests cranial to the trachea and has a balloon much larger than the balloon on an ET tube which when inflated occludes the oropharynx and pushes the base of the tongue out of the way. It can induce a lot of gas into the stomach which is the main reason it is only used for cases under an hour

You use a laryngoscope blade, like a shoehorn, to hold the epiglottis out of the way then slide the tube through the glottis into the trachea. Otherwise the tube will just go down the esophagus, gag reflex or not.I'm a retired surgeon. I'm well aware of the placement of an ET tube. Like I said, I was describing a different product.

As for the cuff, yes, once the tube is in place, you seal around it by inflating a cuff. If you don't then anything in the esophagus can spill into the trachea and air pushed in by the ventilator will just leak out around the tube.which is why people are NPO for 12 hours prior to a general anesthetic so the stomach and esophagus are empty

What I was thinking was something like a permanent tracheotomy (http://www.circlecity.co.uk/sleepdesk/tracheostomy.php) that stays capped when not in use. That would also work however I don't know how that would impact the OP's story. All the patient's that I've seen with permanent trachs either use a voice synthesizer or have to plug the trach to talk. Those that tried to use long term plugs tended to have crud build up in them significantly increasing long term risk of aspiration pneumonia. They also have a significant risk of eventual erosion of the wall of the trachea and then rupturing nearby blood vessels causing exsanguination. However those are risks, not guarantees that any of those complications will happen.

But I like your idea of an old fashioned iron lung. Plus that has the added benefit of assisting circulation. It exposes the whole chest to negative pressure thus pulling air into the lung instead of pushing it in. When we inhale, we also create negative pressure in the major veins around the heart and that assists blood return to the heart. right, plus iron lungs are low tech and kind of creepy sounding and looking which was why I brought it up

frimble3

09-07-2016, 10:25 AM

iron lungs are low tech and kind of creepy sounding and looking which was why I brought it up
I imagine that a modern, not-medically-inclined person coming upon one wouldn't really 'get' what it was: hyperbaric oxygen chamber? Something for cryogenically freezing a body? Really weird coffin?

MaeZe

09-07-2016, 10:30 AM

I imagine that a modern, not-medically-inclined person coming upon one wouldn't really 'get' what it was: hyperbaric oxygen chamber? Something for cryogenically freezing a body? Really weird coffin?

Not necessarily. Have you seen one? Your head sticks out.
http://onairpk.com/wp-content/uploads/2015/09/410.jpg

frimble3

09-07-2016, 11:27 PM

Yes, but if visitors ran across one with no-one in it?

James D. Macdonald

09-08-2016, 03:12 AM

I'm not picturing what you are describing in your first paragraph but you cannot stick a tube down your throat and get it in the trachea without looking. You use a laryngoscope blade, like a shoehorn, to hold the epiglottis out of the way then slide the tube through the glottis into the trachea. Otherwise the tube will just go down the esophagus, gag reflex or not.

I've seen (in training) a video of a gentleman (I believe it was the inventor) inserting one into himself, and continuing to talk through it. Which was really creepy.

Interesting. I've never seen one. It looks like an acceptable replacement for standard intubation. Next time I see the medics I work with I'll ask them if they've seen them used.

Still might be nearly impossible to self-insert one.

MaeZe

09-08-2016, 03:53 AM

Yes, but if visitors ran across one with no-one in it?

Oh it would look extremely weird. I think Trebor found that an interesting element to add to the story.

GeorgeK

09-08-2016, 01:21 PM

It's called an LMA (Laryngeal Mask Airway).. Thank you. I was blocking on the name. It's been a long time

Not necessarily. Have you seen one? Your head sticks out.
http://onairpk.com/wp-content/uploads/2015/09/410.jpg
I've never seen anyone inside one smiling. I also haven't seen one in use since the early 80's probably

bellabar

09-09-2016, 03:35 PM

In the real world, we now have high flow oxygen via nasal cannula which maintains safe oxygenation in a patient for between 15 and 40 minutes of no breathing. Google optiflow for one example.
LMAs are used very commonly in the operating theatre and are also on resus trolleys because they require very little skill to insert. Putting them in yout own throat would be trickier, but YouTube will give you plenty of examples of people who have. Nebuliser local anaesthetic would help and could be an extra piece of equipment for your room.

If I knew I was going to stop breathing for just a few minutes though, I probably wouldn't want anyone trying to instrument my airway. A much simpler scenario would be to have a trusted person use a bag and mask ( you can google that exact phrase) to ventilate me while I can't do it for myself. There's a reason why icu and theatre patients get one on one care, you really want someone around to keep an eye on things.